Provider Demographics
NPI:1881471977
Name:SASSAU, NASTASSJA NAKENA
Entity type:Individual
Prefix:
First Name:NASTASSJA
Middle Name:NAKENA
Last Name:SASSAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 BANYAN TREE TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2369
Mailing Address - Country:US
Mailing Address - Phone:346-377-1516
Mailing Address - Fax:
Practice Address - Street 1:4935 BANYAN TREE TRL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2369
Practice Address - Country:US
Practice Address - Phone:346-377-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies